“ Your virtue is the health of your mind.” For there is no health as such, and all attempts to define a thing that way have been wretched failures. Even the determination of what is healthy for your body depend on your goal, your hori-zon, your energies, your impulses, your error, and above all on the ideals and phantasm of your mind. Thus there are innumerable health of the body; and the more we allow the unique and incomparable to raise its head again, and the more we abjure the dogma of the ‘equality of men,’ the more must the concept of a normal health, along with a normal diet and the moral course of an illness, be abandoned by medical men.
Nietzsche, The Gay Science , 1882
Our minds and bodies consist of subjective experience, which involves sensori-ally or perceptusensori-ally accessible ‘givens’ expressed in different sign systems – such as oral and written languages – and kinds of desire common to all human beings, such as the desire for safety, the desire for love, the desire for recognition. The question of what is the relation between the language we use to capture the forms of experiencing and the material-object-language of the natural sciences seems to be without any clear or real answer. Even though we have better and better knowledge of regular correlations between specific patterns of neuron firing, on the one hand, and instances of conscious experience (data accessed through the senses, conscious, emotional, cognitive, or conative states), on the other, no fully satisfactory explanation of the relations between neural processes and the subjec-tively experienced character of mental states is yet available. Nobody knows, at this time, just what such an explanation might look like. At the same time, we still talk of the veracity of subjective experience. Although, thoughts and attitudes for some people need correction, we cannot assume that subjectivity and conscious-ness are naturally misdirected, a mask for defensive selfishconscious-ness, or a distorting mirror of the truth for all of us ( Joranger, 2015 ).
In fact, consciousness often provides an experience so insistent, so telling, and so truthful that its message about reality is as emphatic as a punch in the nose. Far from a ‘folkish’ mirage or a self-serving mask, subjectivity and personal minds exist to reveal and impel us toward the truth, to liberate us more and more from
biological, psychological, and social burdens, and to permit our best intentions to blossom. So, how can we change and extend the late modern view that we can understand the mind of a person by studying his/her physical brain? How can we think other ways when it comes to mind and subjective experience?
To answer these questions, one has to understand the mind from an interdisci-plinary point of view. Different from the soul, the mind is not some supernatural eternal entity. Unlike the everlasting soul, the mind has many parts, it constantly changes, and there is no reason to think it is eternal. The soul is something some people accept while others reject. Nor is the mind an organ that can be empiri-cally investigated, such as the eye or the brain. Rather, the mind is not a thing. It is a flow of subjective experiences, such as pain, pleasure, anger, and love. These mental experiences are made of interlinked sensations, emotions, and thoughts, which flash for a brief moment and immediately disappear. Then other experi-ences flicker and vanish, arising for an instant and passing away. When reflecting on it, we often try to sort subjective experiences into distinct categories such as sensation, emotions, and thoughts, but in actuality they are all mingled together without, however, being the same. This frenzied collection of experiences stitutes the stream of consciousness. The stream of consciousness is the con-crete reality we directly witness every moment. It is the surest thing in the world ( Harari, 2017 ; McHugh, 2006 ).
The lived truth of the mind relates to existential experiences of our own per-sonal thoughts, perceptions, and feelings as those features belong to our inner selves. We saw in Chapter 1 that this implies feelings expressing the painfulness of pain, the anxiety of anxiety, the redness of red, the delightfulness of love, the reflectiveness and successions of thought, the discomfiture and drive of hunger, and ultimately the ‘me’-ness of me in action. All phenomena obtain their meaning through a subjective first-person perspective, the ‘I’ and ‘oneself.’ In this sense, the subjective mind is the most immediate of our experiences, that of which we are most certain. Our mind in its ‘ownness’ impresses itself upon us at every waking moment and intermittently in dreams during sleep and in our imagination when awake. In fact, there is nothing ‘I’ am more sure of than my consciousness;
I am much more sure of it than any person over against me is conscious of me.
Yet, there seems no bigger mystery than consciousness and the mind in its own-ness. Nevertheless, this mystery is what introduces freedom into life by enhancing choice and robust unpredictability, that is – the radical contingency of insight and truthfulness.
Natural sciences know surprisingly little about mind and consciousness. Anger and love are not abstract terms we have decided to use as a shorthand for bil-lions of electric brain signals. Anger and love are extremely concrete experiences which people were familiar with long before they knew anything about electricity or electrical discharges. Anger and love point to very tangible feelings. If you describe how a chemical reaction in a neuron results in an electric signal, and how billions of similar reactions result in billions of additional signals, it is still worth-while to ask how these billions of events come together to create my concrete
feeling of anger and love. “Scientists don’t know how a collection of electric brain signals creates subjective experiences. Even more crucially, they don’t know what could be the evolutionary benefit of such a phenomenon. It is the greatest lacuna in our understanding of life” ( Harari, 2017 , p. 128).
If no one knows how brain signals create subjective experience, it is hard to understand why the public mental health care system is obligated to help people according to standardized manuals that know nothing about a person’s feelings, imaginations, and experiences. Standardized manuals do not take into account that human consciousness is based on subjective experience and inter-pretations that vary with time, place, and intentions and therefore cannot be understood or treated with standardized medical methods and concepts. There is surprisingly little resistance to the use of these standardized diagnoses and manuals. It seems that social and mental health care workers, who experience the dilemma of using manuals and diagnoses every day, are afraid to oppose the public manual system.
However, there are exceptions. Birgit Valla, a Norwegian psychological spe-cialist, working in a local mental health care system in Stange municipality in Norway, is one of very few mental health care workers who has opposed the public diagnostic system. Valla has established an alternative free mental health care service ‘The Stange Help,’ in Stange municipality. The Stange Help offers services to everyone in the municipality. It is a place to come and talk freely about worries without getting diagnosed. No diagnostic labels are used in The Stange Help. User involvement is taken seriously and the language and meth-ods are based on common sense, that is, people’s needs and wishes come before evidence-based methods and theories.
The Stange Help and Valla’s critique of mainstream psychology
Valla’s opposition to the diagnostic system and mainstream psychology, such as psychoanalysis, started when she was a young psychology student ( Valla, 2014 ).
At the end of her psychological training, Valla started asking questions about the effect of evidence-based psychology and mainstream psychology. The same criti-cal questions followed her in the years to come. In her book Further: How Mental Health Care Services Can Be Better ( Videre: hvordan psykiske helsetjenester kan bli bedre ), she writes that through the years, people have been telling her many stories of how they got better. Her idea was to build a local mental health care service based on what people told mattered to them, and what gave them the desired outcome. Valla’s impression was that if she had these two things in mind, and started to develop the mental health care service this way, she would dis-cover what a successful mental health care service would look like as a result of achieving successful outcomes. Instead of inventing new ways of helping people beforehand, the idea was to detect the solutions along the way. Valla’s experi-ence of mainstream mental health care had shown her that one cannot decide and
discover beforehand through research what a person needs. On the contrary, her experiences had shown that the path to better outcomes had to be discovered, along with the specific person in need for support and help.
Starting with this new and innovative idea, Valla’s challenge was to get other mental health care workers on board with her idea. Because the whole psycho-logical field is caught in the evidence-based paradigm, it seemed almost impos-sible for Valla to get mental health care workers to think differently. However, her objective was clear; they had to get better outcomes in the field of mental health services. The path was more uncertain. When Valla tried to talk about her ideas, people kept asking for the recipe for this new and different way of doing mental health care. If they were to abandon the old way, they had to know the effect of the new way. But, Valla’s idea was anything than rock solid.
According to Valla (2014 ), people want to be good and kind and come along with others. They want to be good parents, a good friend, and a good employee.
They want to get along with their families and have friends. They want their chil-dren to be happy. They want to be able to manage a job or do something of use to others. They don’t want anxiety and depression or to be ruined by alcohol or drug abuse; they want to get out of such states and situations. If they hear voices, they want help to manage the voices so that they don’t bother them as much. They want help to sort out hurtful things that have happened to them in the past. People want to live ordinary lives and feel good about themselves and others.
Keeping it simple has become The Stange Help’s motto. Sadly, the business of psychotherapy and mainstream psychology has become anything but simple, according to Valla. On the contrary, it has become complicated, diverse, over-loaded, and operates within a logic that simply does not apply to the field of mental health care. Valla does not want to be in the business of mainstream psy-chology and psychotherapy anymore, so she is ending her relationship with it. She wants to be in the business of helping people get better and do whatever they have to do to achieve just that.
Seven years after The Stange Help was established, The Stange Help has more than thirty employees helping people of all ages with all types of mental dis-abilities and substance abuse in the municipality of Stange (private conversation).
After years of feedback Valla is utterly convinced that mainstream psychology and its medical model is taking us nowhere. It simply does not work. Many pro-fessionals agree with her on this, but somewhat paradoxically the field continues to adopt its medical and reductionist logic when services are designed. To many bureaucrats, standardized manuals and evidence-based thinking are easier to understand than Valla’s flexible user-based approach to the human mind. Manu-als and evidence-based thinking is linear and orderly, and fits with the idea of guidelines and regulations. Through manuals, you assess to find the proper diag-nosis and the assigned treatment. Contextual perspectives, however, such as life experiences and cultural factors are messy and uncontrollable. But, according to Valla, life experience and cultural factors are essential to understand what people are struggling with. By establishing an alternative approach to the human mind,
Valla, and The Stange Help are openly breaking up with mainstream psychology and the medical model under which it operates.
However, Valla’s road to establish an alternative and more human friendly mental health care service has been hard and problematic. According to the Nor-wegian public mental health care system, not diagnosing people is against rules and regulations. The Stange Help has therefore been under public investigations and found guilty in breaking public mental health care duty. The message was that The Stange Help had to correct its way of working according to public medi-cal standard. Luckily, the Norwegian Minister of health and care services and his ministry came to rescue by approving the way The Stange Help works. The Norwegian Minister of health and care services has concluded that assessments and diagnoses are not always necessary. The approval is quite revolutionary in its message and opens doors that have previously been locked. But it was a close call.
Valla’s critical voice directed to mainstream psychology is echoing other voices representing critical psychology and culture and community psychology. Ian Parker, Peter Kinderman, Isaac Prilleltensky, and Dennis Fox are all known for raising their voices against mainstream psychology. Fox and Prilleltensky (1997) define mainstream psychology and mental health care as the psychology most often taught in universities and practiced by clinicians, researchers, and consul-tants. It is psychology portrayed as a science, with objective researchers and prac-titioners who uncover the truth about human behavior and help individuals adjust to the demands of modern life. Mainstream psychology reinforces, according to Prilleltensky and Fox, Western society’s unacceptable status quo, even when psy-chologists propose tinkering with social institutions. Because psychology’s val-ues, assumptions, and norms have supported society’s dominant institutions since its birth as a field of study, the field’s mainstream contributes to social injustice and thwarts the promotion of human welfare. Indeed, according to Prilleltensky and Fox, the field of psychology itself is a mainstream social institution with negative consequences of its own.
Of course, if existing institutions ensured social justice and human welfare, minor alterations to smooth out the rough edges might be good enough. In our view, however, the underlying values and institutions of modern societies (particularly but not only capitalist societies) reinforce misguided efforts to obtain fulfillment while maintaining inequality and oppression.
( Fox & Prilleltensky, 1996 ) Parker (2007 ) highlights that critical psychology alerts us to the limitations of mainstream research in the discipline. It promises to put ‘social’ issues on the agenda in the whole of Psychology. He points out that people or
a group or culture do not behave or think like the model would predict, and, more importantly, we find that our awareness, our reflection on a process described by a psychologist changes that process. It is in the nature of human
nature to change, to change as different linguistic resources, social practices, and representations of the self become available, and for human nature to change itself as people reflect on who they are and who they may become.
That means that any attempt to fix us in place must fail.
( Parker, 2007 , p. 1) Parker wants us to step back and look at the images of the self, mind, and behavior that mainstream psychologists have produced, the types of practices they engage in, and the power those practices, those ‘technologies of the self’
have to set limits on change. When we appreciate this, we can start to look at what psychologists might do instead as part of a genuinely critical approach.
According to Kinderman (2014a , 2014b ), the biggest issue with introducing the medical ‘disease model’ into the field of mental health care is that the treatment of human’s stress and anxiety rests heavily on diagnoses without taking other mat-ters into account. In the book Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing , Kinderman (2014a , p. 48) states that: “We must stop regarding people’s distress as merely the symptom of diag-nosable illnesses and instead develop a more appropriate system of describing and defining people’s emotional problems.” To Kinderman, traditional psychiatric diagnoses are arbitrary and invalid, and do not map onto biological processes or describe real illnesses. They are also circular concepts, attempting to explain human behavior merely by labeling it as pathological. This reinforces a reduction-ist biological view of mental health and well-being and encourages discrimination and the use of inappropriate medical treatments. The groundbreaking properties of the human mind challenges the medicine method and the diagnostic concepts.
We must move away from the ‘disease model,’ which assumes that emotional distress is merely a symptom of biological illness, and instead embrace a psychological and social approach to mental health and well-being that rec-ognizes our essential and shared humanity.
( Kindermans, 2014a , p. 1)
Humans are humans, creative and unpredictable
In light of contemporary discussions about whether an objective science of psy-chological phenomena is indeed possible, one can conclude that after one century the experts still do not agree on how to explain the human mind as a distinctively psychological phenomenon and not something belonging to a different order.
Based on this fact, the rhetorical questions arise: Can we ever find out what a person is through reliance on general laws? Can we ever objectify or diagnose the way a person experiences things in his/her own mind that is rooted in their feel-ings or opinions? Does a psychological language or philosophical and psychiatric term exist that can express mental phenomena without reference to categories applicable to the external world? ( Joranger, 2015 )
What we know is that the diagnostic examination does not establish the fact of our identity by means of the interplay of distinctions. It establishes that we are different, that our reason is the difference of forms of discourse, our history is the difference of times, that our selves are the difference of masks ( Foucault, 1972 ; Goffman, 1959 ). To Nietzsche (1968 ) there is a list of psychological states that are signs of a flourishing life but that are currently condemned as mental illness even though, under favorable circumstances, they could be defined as healthy. These states include (a) feelings of enhanced power and the inner need to make one’s life a reflection of one’s own fullness and perfection; (b) the extreme sharpness of certain senses, which creates a type of sign language, a condition that seems to be
What we know is that the diagnostic examination does not establish the fact of our identity by means of the interplay of distinctions. It establishes that we are different, that our reason is the difference of forms of discourse, our history is the difference of times, that our selves are the difference of masks ( Foucault, 1972 ; Goffman, 1959 ). To Nietzsche (1968 ) there is a list of psychological states that are signs of a flourishing life but that are currently condemned as mental illness even though, under favorable circumstances, they could be defined as healthy. These states include (a) feelings of enhanced power and the inner need to make one’s life a reflection of one’s own fullness and perfection; (b) the extreme sharpness of certain senses, which creates a type of sign language, a condition that seems to be